Impact of Accompanied Referral and Effective Counseling on Enrolment And Linkage to ART of Newly Identified HIV Positive Clients Toward Achieving Epidemic Control in South-Western Nigeria

Abstract

Very high rates of late or no ART initiation remains a persistent challenge to the achievement of PEPFAR 95-95-95 targets despites new NAIIS report stating prevalence of HIV in Nigeria as 1.5%. This study assessed the impact of accompanied referral (AR) and effective counseling (EC) on enrolment and ART treatment commencement of newly diagnosed HIV positive patients. Methods: This study is a Quasi- experimental and analyzed routine program data on linkage from October 2017 – October 2019 for 45 health facilities in two States in South-West Nigeria. The first 6 months (Q1 and Q2 FY18) had no intervention while accompanied referral (AR) was implemented in Q3 and Q4 FY18. EC was implemented with AR in Q1&Q2 FY19 and was followed up till Q3 and Q4 FY19. Data analysis was done using SPSS and significance fixed at P < 0.05 Results: A total of 6114 newly identified HIV-positive clients were identified; mean age was 35.7 ± 13.9 and 31.5% were in the 30-39 years age bracket. Index Testing contributed 28.7% of the HIV positive Clients identified. Percentage Enrolment in Q1 and Q2FY18 increased from 65.8% and 65.6% respectively to 89.9% and 83.8% in Q3 and Q4 FY18. This increased to 99.6% in Q1FY19, 100% in Q2, 99.7% in Q3 and 99.9% in Q4FY19. Percentage linkage to ART in Q1 and Q2FY18 increased from 61.9% and 65.6% respectively to 85.4% and 75.7% in Q3 and Q4 FY18. This increased to 98.8% in Q1FY19, 99.5% in Q2, 99.7% in Q3 and 99.2% in Q4FY19. Conclusion: AR coupled with EC had the best impact on enrolment, initiation on ART, time to enrolment and initiation.